The US federal regulations indicate that all the nursing services in the country must have enough numbers of the registered and licensed nurses and other personnel in the nursing sector, for adequate provision of services. Increased concerns on understaffing, have increased the unions, and the state and federal government's pressure on staffing guidelines. Through these guidelines, hospitals and the US health systems are placed under pressure to meet the required number of nursing staff. Currently, only 14 US states have laws regulating nursing staffing within their territories; however, only California has a specific guideline on nurses-to-patient minimum ratio within all hospital units.
To participate in the Medicare program, the US federal government requires generalized and broad directions, which hospitals must ensure. In implementing these regulations, hospitals have to review, analyze, and benchmark ways of ensuring the changes do not affect clinical quality, patient experience, and compromise patient safety. Hence, in nursing staffing optimization, hospitals have to analyze the current staffing by shifts and units. The hospitals should then compare their staffing models with those of other healthcare facilities within their region. Various levels of benchmarks are required in achieving the success of these plans. Skill mix, staffing levels, and agency nurse percentages must be benchmarked to achieve the right optimization plans.
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Reviewing the current staffing levels within hospitals helps determine variations leading to negative work productivity, poor clinical quality, and low patient safety and experience. Operational staffing assessment helps in evaluating full-time and part-time nursing staff within your facility. Through this examination, a hospital understands if a change in nursing demographics may change the patient census. This assessment also helps examine staffing procedures and float pool composition, reduce dependency on the agency, and determine possible staffing changes to accommodate higher patient intensity and census. Patient flow is also crucial in the evaluation of the optimization options. The hospital must determine the periods with more patient flows to understand the understaffed areas. Budgeting of paid offs should also be examined to understand the impact of these offs on nursing staffing.
The lack of optimal nursing staffing causes negative patient outcomes. Hospital falls, hospital-acquired conditions, patient mortality, and hospital readmissions result from inadequate nursing staffing. Inadequacy in nursing staffing may also result in, missed nursing care, whereby the standard surveillance and care are not attained, due to the absence of staffing resources. In essence, poor staffing brings the inability to give the needed care, which may also lead to patient and staff injuries, increased turnover, and nurse burnout. Increased staffing turnover causes wastage of healthcare money; these costs include termination cost, recruitment and advertisement costs, hiring costs, and costs involved in the orientation and training of new nurses. Apart from aiding in the optimization of resource expenditure, adequate nursing also helps hospitals achieve good patient outcomes.
Various nurse staffing models and strategies have been adopted over the years. The fixed staffing models rely on standardized nurses' numbers for shifts, units, or nurse-to-patient ratios. The rigid models, however, do not consider the hourly changes within the patient care environment. The flexible staffing models involves the adjustment of nurse-to-patient ratio, either downward or upward, to account for shift level, and unit factors. These factors could include; complexity of care, patient condition, fluctuation in the number of patients, and the required nursing skill level. However, this method shows weaknesses because it does not give enough room for calculations using the existing staff. The method also requires continuous evaluation within the various department and units within a hospital.
